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  • Author: Jennifer W. Cuchna x
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Kristian J. Hill, Kendall P. Robinson, Jennifer W. Cuchna and Matthew C. Hoch

Clinical Scenario:

Increasing hamstring flexibility through clinical stretching interventions may be an effective means to prevent hamstring injuries. However the most effective method to increase hamstring flexibility has yet to be determined.

Clinical Question:

For a healthy individual, are proprioceptive neuromuscular facilitation (PNF) stretching programs more effective in immediately improving hamstring flexibility when compared with static stretching programs?

Summary of Key Findings:

A thorough literature search returned 195 possible studies; 5 studies met the inclusion criteria and were included. Current evidence supports the use of PNF stretching or static stretching programs for increasing hamstring flexibility. However, neither program demonstrated superior effectiveness when examining immediate increases in hamstring flexibility.

Clinical Bottom Line:

There were consistent findings from multiple low-quality studies that indicate there is no difference in the immediate improvements in hamstring flexibility when comparing PNF stretching programs to static stretching programs in physically active adults.

Strength of Recommendation:

Grade B evidence exists that PNF and static stretching programs equally increase hamstring flexibility immediately following the stretching program.

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Cori Sinnott, Hayley M. White, Jennifer W. Cuchna and Bonnie L. Van Lunen

Clinical Scenario:

Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius–soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized.

Focused Clinical Question:

In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?

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Taylor Meier, Brice Snyder, Jennifer W. Cuchna and Johanna M. Hoch

Clinical Question:

In a healthy adult population, which push-up position produces the greatest mean serratus anterior (SA) activation, expressed as a percentage of maximum voluntary isometric contraction (MVIC)?

Clinical Bottom Line:

In a healthy population, there is moderate evidence to support the use of the standard push-up on an unstable surface, elbow push-ups on stable and unstable surfaces, wall push-ups on an unstable surface, the full weight-bearing position using the Cuff Link system, and all three hand positions (shoulder width, wide base, and narrow base) with and without the use of the Perfect Pushup™ handgrips for the purpose of SA strengthening. These exercises produced a mean SA activation of at least 50% of the MVIC in the four cross-sectional studies that were reviewed for this critically appraised topic.

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Jennifer W. Cuchna, Lauren Welsch, Taylor Meier, Chyrsten L. Regelski and Bonnie Van Lunen

Clinical Question:

Are Nordic hamstring exercises more effective than standardized training in reducing hamstring strain injury rates in competitive soccer players over the course of at least one season?

Clinical Bottom Line:

The evidence supports the use of Nordic hamstring exercises to reduce hamstring injury incidence rates over a competitive soccer season. Therefore, progressive Nordic hamstring exercises should be included within some aspect of a practice to prevent the occurrence of hamstring injuries.